Opinion: The danger of letting primary care be a rescue path for burned-out specialists

One of the best-known effects of the Covid-19 pandemic has been the stress and sense of being overwhelmed experienced by frontline health care workers. Often under-resourced and taking casualties within their own ranks, they have been straining under the weight of responsibility to care for a tsunami of Covid casualties. In the center of this relentless firestorm has been the emergency medicine physician, who have been called to give more of themselves than should ever be asked of anyone. Their burnout and exhaustion is unsustainable.

Perhaps it was the pandemic that sparked an emerging, yet largely unreported phenomenon I’ve witnessed firsthand in which emergency medicine physicians are leaving their work and opening independent primary care practices in the direct primary care sector of health care. Direct primary care operates at the fringes of the health care industry, funded by subscription-based payments that patients usually pay out of pocket. No insurance billing means no credentialing, no quality reporting, no oversight of any kind. Many primary care physicians have sought refuge in this model to escape the insurance-based toxicity of the traditional fee-for-service payment system — and anecdotally, it’s working. The direct primary care model seems better for both primary care providers and their patients. Win-win. And without regulatory and reimbursement oversight, the rules are honorary, leaving room for much-needed innovation but also for interlopers.

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